Provider Demographics
NPI:1700896669
Name:ROSS, NANCY J (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:21685 GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5927
Mailing Address - Country:US
Mailing Address - Phone:408-973-1001
Mailing Address - Fax:408-973-9164
Practice Address - Street 1:21685 GRANADA AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5927
Practice Address - Country:US
Practice Address - Phone:408-973-1001
Practice Address - Fax:408-973-9164
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW #9928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health